The current priorities of nursing research, according to the National Institute of Nursing Research (NINR) (2011), are "improving health promotion and disease prevention, improving quality of life by managing symptoms of acute and chronic illnesses, improving palliative and end-of-life care, enhancing innovation in science and practice, and developing the next generation of nurse scientists" (p. 7). These priorities are suitable because they deal with the work that nurses do as well as nursing education. These are the most vulnerable populations in terms of health. Priorities should not be restricted to these areas. They may be broadened to guarantee that the evidence acquired aided in the delivery of evidence-based care. Nursing researchers need to comply with the priorities set out by the NINR because it will affect the applicability of their research evidence, and other issues like funding.
For practice to be considered evidence-based it should fulfil the three main values of integrating of best research evidence, clinical expertise and patient values (Prendergast, 2011). Best research evidence here is graded according to its quality in relation with the research question, for instance experimental studies. The second criteria is clinical expertise which involves combining research with experience as well as patient values. Finally, the patient values which means that evidence-based practice appreciates that fact that a particular intervention or treatment is likely to be effective if it responds to the specific preferences, problems and sociocultural context of the patient (American Psychological Association, 2006). Quality plays a key role in evidence-based practice. Through the three main criteria, quality is the distinguishing aspect. In best research evidence, evidence is graded according to its quality in answering the research question. At the same time, in clinical expertise quality determines the best training and experience used in decision-making. Also, in integrating patient values, clinical experience takes precedence in specific situation to determine which client values are to be considered.
Research Proposal: Rates and Causes of Medical errors
The research will be based on the topic of medical errors in nursing. The objective of the study will be to establish the rates and causes of medical errors by nurses. There is an agreement in literature that medical errors cause harm risk patient health in healthcare setting. Actually, it has been estimated that medical errors is the third cause of death in the U.S. In this regard, it is important to determine the rates and causes of errors by nurses in a bid to develop strategies and policies to reduce medical errors.
Literature Review
Makary and Daniel (2016) is one of the landmark studies in regards to medical errors. In their study, they concluded that medical error is the third leading cause of death in the U.S. This study raised an alarm since death being cause by medical care itself. Weeks (2016) says that medical errors as laid out by Makary and Daniels (2016) entails: an unintended act, that is, commission or omission; acts which do not achieve the intended outcome; use of wrong plan and deviation from process of care. The major reasons for medication errors have been categorized into human and systems dimensions. The Institute of Medicine (2002) report “To Err is Human” suggested that making errors is part of a human condition. From this premise, this research will seek to investigate the human factor in medical errors in nursing; the rate and causes.
Hypothesis
The hypothesis of this research is that; lack of collaboration between medical practitioners in healthcare setting are the major cause of nursing errors. This hypothesis is founded on the person approach where physicians, nurses, pharmacists, surgeons, anaesthetists, and other medical staff are supposed to present barriers to err through collaboration.
Theory
The research is based on the Swiss cheese theory of error (Reason, 2000). According to this theory every process of care has the potential of failure (error). Each of the practitioners involved in caring for the patient has a defensive layer of avoiding medical error. As such, if medical errors occur, there is no defensive layer between the many practitioners involved in care.
Study design model
The study will employ the cross-sectional survey model in a major hospital to determine the frequency and reasons documented for medical errors.
Method
Using a random sampling, study subjects will be selected to report on their experiences with medical errors. Data will be collected using questionnaires and interviews. Interpretation and analysis of data will be done using ANOVA.
Anticipated Results
The study anticipates that cases of medical errors in nurses are under reported. Study subjects are likely to disclose errors they might have been involved in but did not report them. Additionally, there is likely to be a blame attitude among nurses in medical errors episodes. Instead of an analysis of why an error happened, there is the likelihood that people blame each other. Finally, the study is likely to establish a low collaboration between medical staff involved in patient care, a case that results in medical errors. In this regard, it is also likely that participants are not aware of the ways that collaboration can be done to reduce medical errors.
Potential Dissemination Avenues
The results of this study can be published in medical and nursing journals. They can also be shared in conferences and proceedings where nursing errors are discussed. Again, they can be used by nursing students to help their researches as well as to inform literature review. The health care facilities can also use this study to implement research appraisals which will lead to evidence based practice.
References
American Psychological Association (2006). Presidential Task Force on Evidence-Based Practice. Evidence-based practice in psychology. American Psychologist, 61 (4):271–85.
Kohn LT, Corrigan JM, and Donaldson MS, editors. (2002). To err is human: building a safer health system. A report of the Committee on Quality of Health Care in America, Institute of Medicine. Washington, DC: National Academy Press.
Makary, M. A & Daniel, M. (2016). Medical error- the third leading cause of death in the U.S. British Medical Journal, 353, doi: https://doi.org/10.1136/bmj.i2139
National Institute of Nurse Research (2011). Bringing Science to life NINR strategic plan 2011. Retrieved from https://www.ninr.nih.gov/sites/www.ninr.nih.gov/files/ninr-strategic-plan-2011.pdf
Prendergast, M. L. (2011). Issue in defining and applying evidence-based practice criteria for treatment of criminal-justice involved clients. Journal of Psychoactive Drugs, 7, 10-18.
Reason J. (2000). Human error: models and management. British Medical Journal, 320:768–70
Weeks, J. (2016). Integrative health: implications from a report that medical errors are the USA’s third leading cause of death. The Journal of Alternative and Complementary Medicine, 22(7), 493-495.
